Vomiting In Babies – When To Panic?

Most new moms are often worried about their baby’s food intake, and the texture of their poops. But one other topic which is a point of concern is vomiting/ frequent spit-ups. Most general questions around vomiting in newborns, infants and children are related to what caused it, the volume and projectile of throw-ups.

Most pediatricians suggest parents get used to this to some extent, and to also adopt the popular wait-and-watch policy. Often vomiting is accompanied with no to low-grade fever with or without any other symptom.

On the positive side, most causes and symptoms of vomiting in babies go away on their own.

One thing a parent needs to observe is- whether it’s vomit or a spit-up?

Babies normally spit-up small amounts at any given time, but most often when being burped. But vomiting usually happens right after they’ve been fed (it could be breastmilk or weaning foods), or some underlying illness.

Spit-up is also commonly related to:

1. Fast feeding

2. Swallowing air

3. Forcefully feeding a lot more than the baby’s tummy can hold (very hard to understand, but with time, a mother/father/caregiver gets acquainted with baby’s eating/feeding capacity)

It is equally difficult to comprehend the difference between vomiting and spit-up. But, a common trend or pattern often suggests they should be treated as two different incidents.

Babies tend to spit-up even without any of the factors mentioned above, as suggested by Doctor Himanshu Sharma, a Gurgaon-based pediatrician. Occasional vomiting may also be normal, but repeated vomiting is abnormal. Usually, at the onset of introducing new foods to a 6-month-old baby, one can expect spit-ups and vomits. This is why, we always advise including soft, versatile healthy cereals, which if given in small quantities can keep your child full. Ragi is an ideal first-food. Ragi porridge, Ragi Kheer made using sprouted ragi cereal, ragi halwa, and a lot of other baby foods can be prepared using this supergrain.

Vomiting can’t be controlled. It comes out forcefully because of the triggered action in the tummy muscles which then sends a message to the brain’s “vomiting center” to squeeze it. 

Most times mothers often think or tell others, “the baby has vomited curd/fermented milk.” It’s because the vomit is mixed with stomach juices. This is often coupled with a slight cough. If your baby has been spitting-up or vomiting often, you’d know this sign is to warn you to grab a towel, bucket, or burp cloth, to ensure you aren’t wasting too much time cleaning up later.

Additionally, spit-up is normal and is not normally triggered due to foods, but vomiting in most cases is an issue related to digestive enzymes not functioning properly or perhaps any other underlying illness.

Possible causes of vomiting without a fever:

1. Feeding issues/habits

Babies are new to the concept of being fed and taking milk down. Along with spit-up, a baby may vomit occasionally after being fed. This is most common in the first few months of his/her life. But let your baby’s doctor know if the throw-ups are frequent. It could be due to a food allergy or something in the mother’s diet which isn’t suiting the little one’s tummy. If the baby is very forcefully vomiting. Then it could be a sign of an underlying problem that needs to be identified and resolved immediately.

2. Tummy bug

Also known as gastroenteritis or tummy bug is often one of the culprits. Stomach flu causes cyclic vomiting patterns that will show in 24 hours to confirm the next steps for treatment recommended by the pediatrician.

Other symptoms which may last for 4 days or longer:

1. Poop texture: Runny, watery

2. Mental health/mood: Irritability or crying

3. Appetite: Loss or poor appetite

4. Stomach healthy: Stomach cramps and pain- a baby will not be able to express it, but the way to know that a baby’s stomach is cramping is by feeling the lower abdomen. If it’s too tight, it means the stomach’s health is poor.

The tummy bug can also cause a fever, but this is actually less common in babies.

Gastroenteritis (acute stomach bug) is a sign to worry about. A normal poop lab test can determine the bacteria or virus type.  Your child’s pediatrician would be the best one to advise any medication (if needed) for the simple reason that severe gastroenteritis can lead to dehydration.

3. Infant reflux 

A lot of babies suffer from infant reflux aka acid reflux (GERD) in adults. A baby suffering from this issue usually shows signs in the first weeks or months of his/her life.

According to Dr. Himanshu, “Vomiting from acid reflux happens when the muscles at the top of the stomach are too relaxed.” Therefore, immediately after being fed breastmilk or formula,  vomiting is triggered.

With each passing month, the baby’s stomach muscles strengthen, and his/her digestive system is developed.

Dr. Himanshu suggests babies with reflux to be handled with care during their feeding/meal times, e.g. keep close tabs on the symptoms when the baby is done being fed, give smaller, but more frequent feeds, always burp your baby often, do not overfeed at any given cost.

You can also thicken milk or formula with more formula or a bit of baby cereal. Caveat: Check with your pediatrician before you try this. It might not be suitable for all babies.

4. Motion sickness

Some babies and kids are prone to motion sickness. They feel uncomfortable and their tummy feels funny or bloated/gassy when they are fed in the car/plane or anything in motion.

Motion sickness can cause vomiting. Under such circumstances, it is suggested to keep their head well supported in the car seat.

5. Low to zero tolerance to milk

Milk intolerance is also termed as galactosemia. According to Dr. Himanshu, “It happens when babies are born without a certain enzyme needed to break down sugars in milk. Some babies with this condition are even sensitive to breast milk.”

Babies born with lactose intolerance are unable to digest milk and dairy food products. Babies are screened at the time of birth for galactosemia. They are often put on a formula-feed which has lactose-free ingredients. But vomiting is generally common in babies with lactose intolerance (when fed foods with traces of dairy).

6. A rare health condition in babies

Rare in babies, called pyloric stenosis is a condition in which an opening between the stomach and intestines is either too narrow or blocked. The most obvious symptom, in this case, is a hungry, constipated, baby. It can also lead to forceful vomiting after feeding.

This rare condition can be treated with surgery. During your baby’s routine check-ups, make sure to tell your pediatrician any significant symptoms pertaining to the number of wet diapers, tight motion, frequency of feeds, etc. 

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There can be other issues for baby vomits, such as cold-related flu or an ear-infection or perhaps weather change and therefore difficulty in getting acclimatized. Dr. Himanshu recommends that if the severity of symptoms is unmanageable, it is best to immediately speak to the baby’s pediatrician. Take an appointment and also do a quick lab test by sending a poop sample for testing. 

Most times, baby vomiting is not a cause for mums or dads to worry about. Hope this blog helps. We would advise you to consult your pediatrician if you feel that the baby isn’t really spitting-up, but it’s actually vomiting, really and of high frequency. If you feel like you have waited 24 hours and there is no relief, if the baby is dehydrated and also irritated, you know the signs are clear. Take a deep breath, don’t panic and follow your baby’s doctor’s instructions.